Ankylosing Spondylitis – Exercise Recommendations

Ankylosing Spondylitis - Exercise Recommendations Thumbnail

Ankylosing spondylitis (AS) is one type of arthritis, an inflammatory condition that can cause the ligaments, joint capsules, and tendons that attach to your spine to swell (enthesitis). Moreover, as time goes by, this can lead to bone formation and possible fusing of the vertebrae. This type of arthritis can certainly result in a loss of flexibility. Read on to find out more about Ankylosing Spondylitis Symptoms, Causes, Treatments, and Exercises.

Ankylosing Spondylitis Symptoms

Early symptoms include:

  • Pain and stiffness in the lower back and hips, especially in the morning and after periods of inactivity. 
  • Neck pain and fatigue. Over time, symptoms might worsen, improve or stop at irregular intervals. The areas most commonly affected are:
    1. The joint between the base of the spine and the pelvis.
    2. The vertebrae in the lower back.
    3. The places where tendons and ligaments attach to bones, mainly in the spine, but sometimes along the back of the heel.
    4. The cartilage between the breastbone and the ribs.
    5. The hip and shoulder joints.

Since the disease can also affect other areas of the body, other symptoms may develop, and these may include:

  • Pain, stiffness, and inflammation in other joints, such as the ribs, shoulders, knees, or feet.
  • Difficulty taking deep breaths if the joints connecting the ribs are affected.
  • Vision changes and eye pain due to uveitis, which is eye inflammation.
  • Fatigue, or feeling very tired.
  • Loss of appetite and weight loss.
  • Skin rashes.
  • Abdominal pain and loose bowel movements.

Ankylosing Spondylitis Exercises-Symptoms

Causes Of Ankylosing Spondylitis

There is no known specific cause of Ankylosing spondylitis (AS), though genetic factors are involved. In particular, people with a gene called HLA-B27 are at a greatly increased risk of developing ankylosing spondylitis. However, only some people with the gene develop the condition.

Treatment And Management

This condition is lifelong and has no cure, but treatments can prevent long-term complications, reduce joint damage, and ease pain.

Treatments include:

  • Ankylosing Spondylitis Exercises
  • Non-Steroidal Anti-Inflammatory Drugs
  • Disease-Modifying Anti-Rheumatic Drugs
  • Corticosteroids
  • Surgery

Ankylosing Spondylitis Exercises

The good news is that regular exercise — even 5 to 10 minutes each day — can increase flexibility and strengthen muscles that support your back and neck. When it comes to exercising with pain-free low- or no-impact activities, such as yoga, tai chi, swimming, walking, or cycling, are best for people with joint pain. These exercises may be done at home, in a pool or gym, or in a group or individual physical therapy program.

Activities include: 

1. Breathing Exercises


Breathing exercises are critical for maintaining flexibility in your rib joints to keep you breathing easily. Also, these exercises are a great way to begin and end your workout.

One example of a breathing exercise is:

Take a deep breath, filling your chest with as much air as possible. Then, hold your breath for three seconds. Afterward, slowly exhale through your mouth.

2. Flexibility Exercises

Ankylosing Spondylitis Exercises-Flexibility Exercises-Plank


Ankylosing Spondylitis Exercises-Flexibility Exercises-Side Bend

Side Bend

Yoga and tai chi effectively improve spinal flexibility and low back pain. Flexibility exercises strengthen muscles by holding a position rather than moving between different positions—to increase the range of motion. Moreover, flexibility exercises gently stretch and extend your spine, keeping joints flexible and warding off stiffness. Pelvic flexibility is especially important because the hips play an important role in keeping the spine stable and help relieve strain and maintain the range of motion in the hips.

3. Floor Hip Flexor Stretch

Ankylosing Spondylitis Exercises-Floor Hip Flexor Stretch

For this Ankylosing Spondylitis Exercises, lie on your back with your left leg extended on the floor, your right leg bent at the knee, right foot flat on the floor. Then, rest your shoulders against the floor. Place your hands on the back of your right thigh and slowly pull your right knee toward your trunk. Holding this position, now flex your left foot while pressing your left thigh and calf down into the floor. After that, notice a stretch in the front of your left hip and the top of your thigh.  Then, hold for 10 to 30 seconds as you focus on gently lengthening the involved muscles.  Lastly, return to the starting position and repeat the process with the other leg.  Repeat two to four times.

Swimming is a great way to increase spine flexibility without jarring. It also helps to increase flexibility in your neck, shoulders, and hips. It may be easier to perform aerobic exercises while in the pool.

4. Strengthening Exercises

Strengthening Exercises-Squat


Strengthening Exercises-Low Lunges

Low Lunge

Strong back muscles support your posture, which is important for anyone with AS. Keeping the spinal muscles strong also allows them to support the joints. Heavy lifting is not needed to strengthen the back muscles; light hand weights and resistance training using the body weight can still be effective. 

5. Superman

Superman 1

Superman 2

Firstly, lay with your stomach on the ground. Secondly, take a few slow, deep breaths and let them out slowly to relax your body. Thirdly, draw your belly button in towards your spine to engage your stomach muscles. Fourthly, Extend your arms in front of you, palms facing down. Then, lift your head, chest, and arms off the ground as far as possible, then bend your legs and lift your thighs off the ground to create a “U” shape with your back, arms, and legs. After that, hold this position for one to two seconds, then slowly lower your body back to the floor. Lastly, repeat steps one through five several times. Stop if you feel pain!

Good Posture Techniques

Practicing good posture techniques also can help you look and feel much better

  • Sleeping Posture

Sleep with your spine straight, if possible. To encourage this position, your mattress should be firm but not too hard. Sleep on your stomach if you can, and don’t use a pillow. Alternatively, you can sleep on your back and use a thin pillow or one designed to support your neck. Avoid sleeping with your legs curled, and also keep them as straight as possible.

  • Lying Posture

You should perform this Ankylosing Spondylitis Exercises on a firm surface. Use your bed if it has a firm mattress, or place a mat on the floor. Lie face down for 15 to 20 minutes. (If you can’t do this comfortably, you may use a pillow under your chest and place your forehead on a folded towel.) You may keep your head downward, turn it to one side, or alternate sides.

You may not be able to do this for 20 consecutive minutes. That’s fine. Begin with whatever feels comfortable and increase the time as you gain strength.

Before engaging in these exercises, please consult your doctor if these are safe for your Ankylosing Spondylitis. 

Exercises To Avoid

Exercises and any sports that can cause a lot of jarring to the joints, such high impact exercises, should be avoided.

These exercises include:

  • Burpees
  • Jump squats
  • Jumping jacks
  • Running 
  • Intense hiking
  • Tennis and racquetball
  • Football
  • Basketball, and 
  • Soccer 

Steps To Ease Pain And Inflammation

In addition to standard AS treatments, the following steps may also help ease inflammation and pain:

1. Eat Healthy Choices

Choose a Mediterranean diet, as this type of diet may help fight inflammation. Avoid or eat fried foods, processed meats, and foods high in fat and sugar minimally because these foods can have an inflammatory effect.

Eat Healthy Choices

2. Maintain A Healthy Weight

Obesity and excess weight put pressure on joints and bones.

3. Avoid Alcohol

Drinking too much alcohol can weaken bones and increase the risk of osteoporosis.

4. Stop Smoking

Tobacco use accelerates spinal damage and intensifies the pain. Your provider can help you quit smoking.


In conclusion, Ankylosing spondylitis (AS), a form of arthritis usually affecting the spine, is a life-long condition without a cure. The symptoms of Ankylosing spondylitis (AS) may gradually worsen as you age. Though the condition is rarely disabling or life-threatening, the symptoms may still interfere with your ability to do the things you love. Early interventions should be done to ease inflammation and pain to enjoy a long, productive life. Lastly, your healthcare provider can help you with the steps you can take to stay active and manage symptoms.

In most cases, for most people, exercise is the best way to reduce your arthritis pain, stiffness, and swelling, restore normal functionality and range of motion of your joints, and get you back to a pain-free life once again. Have long-term relief from pain, stiffness, and swelling with our Arthritis Handbook!

Arthritis Handbook